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Federal forms, ICRs, and supporting documents

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Form 1095-A- Health Insurance Marketplace Statement

IC 213666 under ICR 202408-1545-001 · OMB 1545-2232.

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Document Type
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Instruction
Instruction
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Information Collection (IC) Details

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Form 1095-A- Health Insurance Marketplace Statement
 
No Modified
 
Mandatory
 
26 CFR 1.36B–5

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1095-A Health Insurance Marketplace Statement f1095-a--2024-00-00 (draft).pdf Yes Yes Fillable Fileable
Instruction i1095-a--2023-00-00.pdf Yes No Printable Only

General Government Taxation Management

IRS 24.030- Individual Master File, IRS 24.046-Customer Account Data Engine Business Master File, and IRS 34.037- Audit Trail and Security Records System  80 FR 54064

15 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,250,000 0 0 0 0 3,250,000
Annual IC Time Burden (Hours) 16,250 0 0 0 0 16,250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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